Intravesical Mitomycin C
Mitomycin C is an antibiotic that also kills tumour (cancer) cells. It has been used with significant effect in patients with certain types of bladder cancer (those which are not growing deeply into the wall of the bladder). In order to treat a patient, the mitomycin is instilled directly into the bladder through a catheter.
Mitomycin may be used for three different reasons in the bladder. While the intended outcome is not guaranteed, a huge body of literature supports its use in an attempt to:
- Kill remaining bladder cancer cells that may still exist after the primary tumour has been surgically removed
- Prevent new tumours from developing after all known tumour cells have been eradicated
If you are currently sick (ie. a severe cold or flu) or have gross haematuria (blood in the urine that you can actually see), you must tell you’re the doctor as Mitomycin C treatment may need to be withheld until you heve been evaluated. It will also not be given if a bladder infection is present.
Mitomycin does not work well in acidic urine. For that reason, you should take 2 sodibic tablets on the night before treatment and 2 tablets on the morning of treatment (you can obtain these from your pharmacy without prescription).
The Procedure Itself
The initial treatment of Mitomycin C is once a week for 6-8 consecutive weeks. Maintenance treatments for prevention of future tumour recurrences vary and you will be given a very specific schedule if you are going to be enrolled in a maintenance program.
You will lie down on your back on a bed. Under sterile conditions, a small, soft catheter will be gently advanced into your urethra and into your bladder. All of the urine in your bladder will be drained. Once your bladder is empty, the Mitomycin C will be slowly poured into the catheter through a large syringe or funnel attached to the catheter. The medicine is allowed to slowly run into the catheter until it is all administered. The amount is small and is usually far less than the volume capacity of your bladder. The catheter may then be removed, or, alternatively, clamped and then released at the end of the treatment.
It is important for you to hold the medicine in your bladder for two hours so that the medicine can remain in contact with the inner lining of the bladder for an adequate period of time. If you typically have a problem holding urine for that long, you may want to limit fluid consumption for a few hours prior to the treatment. Certainly, caffeine containing beverages (coffee, tea, etc.) should be avoided that day prior to your appointment. These drinks will make you have to urinate more frequently.
You might have a little stinging in the urethra the first time you urinate. This is usually due to the catheterization and is not a cause for concern. Each week, the stinging may last a bit longer than the prior week. This is due to cystitis (inflammation of the bladder wall) and/or urethritis (inflammation of the urethra). Although the sensation can last for two to three urinations after several weeks of treatment, it is rare for it to persist beyond the day of the treatment. In 25% of patients, there may be a little blood in the urine with the first few urinations after each treatment. It will typically resolve in one to two days. If the urine is not clear to the eye by the next week, the following treatment might be delayed for a few days more.
Possible Complications of the Procedure
The majority of patients will not experience any problem after Mitomycin C therapy. However, any procedure, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. These may include, but are not limited to:
- Urinary Tract Infection or Urosepsis (Bloodstream Infection)
Even from a minor and sterile procedure, it is possible for you to get an infection with bacteria that typically cause urinary tract infections (UTIs). It may be a simple bladder infection that presents with symptoms of burning urination, urinary frequency and a strong urge to urinate. This will usually resolve with a few days of antibiotics. If the infection enters the bloodstream, you might feel very ill. This type of infection can present with both urinary symptoms and any combination of the following: fevers, shaking chills, weakness or dizziness, nausea and vomiting. You may require a short hospitalisation for intravenous antibiotics, fluids, and observation. This scenario is more common in diabetics, patients on long-term steroids, or in patients with disorders of the immune system.*If you have symptoms suggesting any of the above after your discharge from the hospital, you must contact us immediately or go to the nearest casualty department.
- Blood or Blood Clots in the Urine
As previously mentioned, Mitomycin C can cause cystitis (inflammation in the bladder). Severe inflammatory changes in the bladder can result in haematuria (blood in the urine). In almost all instances, the urine clears on its own over the next day or so. If severe, the blood can form clots and block the flow of urine. This is more common in men who may already have a partially obstructing prostate gland. The treatment may be placement of a catheter to drain the urine from the bladder and/or irrigating the clots out of the bladder.
- Urinary Retention
Even in the absence of bleeding in men, the prostate can become inflamed secondary to delayed infection. As a result, the flow of urine can be blocked. In this instance, you should go to your nearest casualty for assessment.Those most at risk are men who already have difficulty urinating before the procedure due to BPH (Benign Prostatic Hyperplasia).
- Urethral Strictures
Strictures are narrow, scarred tissue areas. Although uncommon, any patient who is catheterized often can develop scar tissue months or years later. Strictures are typically treated with minor, minimally invasive procedures.
- Palmar, Genital, and/or Facial Skin Rashes
Mitomycin C can sometimes cause skin irritations or rashes on the hands, genital area, and even on the face where direct contact with the drug does not occur. One should be cautious with the first urination so as to minimize splashing. Afterward, it is important to carefully wash your hands.
In very rare instances, Mitomycin C can affect the bone marrow’s ability to produce certain types of cells. Once recognised, the treatment would be discontinued. Typically, the problem is reversible as new bone marrow cells develop.
Please contact the office within 3 days of discharge. You should make an appointment to see Dr Sved as directed in the hospital. You may see him in his offices at RPA, Bankstown or Strathfield Private Hospital. Do not hesitate to call at any time if you have any concerns. In the long term, regular cystoscopic examinations will be required to look for any sign of cancer recurrence.